A study on the effect of propranolol on the portal venous pressure and systemic hemodynamics in patients with chronic liver disease

Abstract

The effects of propranolol on portal venous pressure were evaluated in 17 patients with hepatic cirrhosis, three with precirrhosis, one with PBC and one with chronic aggressive hepatitis.
After intravenous infusion of 5mg of propranolol for 10 minutes, wedged (WHVP) and free hepatic venous pressure (FHVP), estimated hepatic blood flow (EHBF), cardiac index (CI) and total systemic vascular resistance (TSR) were measured.
Thirty minutes after the initiation of the infusion, portal venous pressure (PP: WHVP-FHVP) decreased significantly by 26% and this effect persisted for 60 minutes. The heart rate, CI and EHBF were reduced significantly by 12%, 21% and 14%, respectively, whereas TSR increased by 28%. In 6 patients with cirrhosis, the serum propranolol level measured by high liquid chromatography registered 16.2±5.3ng/ml 30 minutes after the infusion.
After the infusion of vasopressin (0.2U/min), given for a comparative study with propranolol, PP decreased by 36% at 5 minutes. However, the difference of reduction in PP between the two agents was insignificant.
Following the oral administration of 30mg of propranolol per day over a period of one month to 8 patients with cirrhosis, the serum propranolol level measured in fasting state in the morning was 37.8±20.Ong/ml.
The present investigation demonstrates that the intravenous administration of 5mg of propranolol results in a sufficient serum concentration of propranolol and a significant reduction in PP. It was also found that the serum concentration of propranolol can be maintained if a dosage of 30mg of propranolol per day is administered to patients with cirrhosis. Consequently, it is well documented that this dosage would serve as a suitable treatment of portal hypertension in cirrhotic patients.